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Role of infection control in patient safety [compatibility mode]

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Infection Control and Patient Safety …

Infection Control and Patient Safety
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.


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  • 1. 1
  • 2. What is Patient Safety? In its simplest form, patient safety is “prevention of harm to patients.” ٢
  • 3. Infection Control • Infection control (IC) is a quality standard that is essential for the well being and safety of patients. • It affects most departments of the hospital and involves issues of quality, risk management, clinical governance and health and safety. ٣
  • 4. ٤
  • 5. International Patient Safety Goals Identification Communication Medication Eliminate Infection Falls ٥
  • 6. Identification Identify Patients Correctly  Use at least two (2) ways to identify a patient ٦
  • 7. IPSG.1 Identify Patients Correctly   A collaborative process is used to develop policies and/or procedures that address the accuracy of patient identification Use at least two (2) ways to identify a patient: • • • • •  giving medications giving blood and blood products taking blood samples taking other samples for clinical testing providing treatment or procedure The patient’s Room Number cannot be used as an identifier ٧
  • 8. Verification Process Correct Patient (Identification) Scope: All radiology procedures  Ask the patient “What is your FULL NAME?” “What is the name of the PROCEDURE you are having today?”. Also ask SITE/SIDE if required  Never state patient’s Name “Do not tell the patient… the patient tells you” E.g. Call “Mr. Abdullah”, then ask the above questions including additional questions related to clinical history as outlined on Request Form ٨
  • 9. Correct Patient (Identification) Cont.  Inpatients 1. Ask patient to state Full Name/ Procedure 2. Check responses against Referral Form & Patient ID Band (wrist/ankle) including MRN– MANDATORY Do Not Proceed if :  Patient ID Band is absent. Call Ward Nurse to personally ID patient and complete Time Out Verification sticker (all personnel sign).  Patient can not verbalise identity. Nurse Escort must verify patient identity. Complete Time Out Verification sticker (all personnel sign). ٩
  • 10. Verification Process - Cont.  Outpatients 1.Ask patient to state Full Name/ Procedure 2.Check responses against Referral Form Do Not Proceed if :  Patient can not verbalise identity. Proceed only after :  Identity is verified by accompanying relative, family member, friend or healthcare interpreter. ١٠
  • 11. Reinforcing the Message Displayed at all imaging consoles Have you checked the Patient ID ? - Prior to the Procedure Asked patient their: • Name • (Procedure) Are you sure ! Checked response & MRN against ID Band & Request Form ١١
  • 12. Communication Improve Effective Communication  Implement a process/procedure for taking verbal or telephone orders ١٢
  • 13. IPSG 2: Improve Effective Communication  A collaborative process is used to develop policies and/or procedures that address the accuracy of verbal and telephone communications  Person receiving the following: • Verbal order • Telephone order • Reporting of critical test results Must use a verification “read back” of complete order or test result  The order or test result is confirmed by the individual who gave the order or test result ١٣
  • 14. Critical Test Results  Ensure that there is collaborative process to determine what they are  Clinical Laboratories      Bedside testing Imaging Studies Electrocardiogram Pulmonary Function Testing other ١٤
  • 15. “Do Not Use” list:      u IU qd qod Leading decimal point (always use a Leading zero)  Trailing zero ١٥
  • 16. Medication Safety Improve the Safety of High-alert Medications Remove concentrated electrolytes from patient care units ١٦
  • 17. IPSG 3: Improve Safety of High Alert Medications   A collaborative process is used to develop policies and/or procedures that address the location, labeling and storage of concentrated electrolytes Concentrated electrolytes are not present in patient care units unless clinically necessary and actions are taken to prevent inadvertent administration in those areas where permitted by policy Remove concentrated electrolytes from patient care units ١٧
  • 18. Eliminate Eliminate Wrong-site, Wrongpatient, Wrong-procedure Surgery  Use a checklist, including a “timeout,” before surgery  Verify that documents and equipment are correct and functioning properly before surgery  Mark precise site where surgery will be performed ١٨ ١٨
  • 19. IPSG 4: Ensure Correct-site, Correctprocedure, Correct-patient Surgery  Collaborative process used to develop P&P  Mark the precise site in clearly understood way and involve patient in doing this  Develop process or checklist to verify correct documents and functioning equipment  Use a Checklist including “Time-Out” just before surgical procedure ١٩
  • 20. Team Time Out – Interventional (invasive) Radiology (All invasive procedures covering CT / Ultrasound / Angiography / Mammography and selective Screening procedures) In procedure room, with patient present. Confirm patient ID, request/consent forms, image data all correct. Site marked by interventional doctor. Team Leader calls Time Out immediately prior to procedure commencement (patient draped) to confirm:  Verification of patient identity (Full Name/MRN/ID Band)  Agreement on the intended procedure  Verification of correct position i.e level & side  Verification of the visible marked site  Availability of correct implants/equipment/medication – DO NOT proceed until resolve discrepancies (document) ٢٠
  • 21. Universal Protocol DOCUMENTS SURGERY SITE EQUIPMENT PATIENT BODY PART PROCEDURE ٢١
  • 22. Infections Reduce the Risk of Health Careacquired Infections A collaborative process is used to develop P&P that address reducing the risk of health care–associated infections   Comply with current published and distributed hand hygiene guidelines IPSG 5: Reduce the Risk of Health Care-Associated Infections. ٢٢
  • 23.  Contact Precautions  Airborne Precautions  Droplet Precautions ٢٣
  • 24. Falls Reduce the Risk of Patient Harm Resulting from Falls  Assess and periodically reassess each patient’s risk for falling ٢٤
  • 25. FALLS  Falls are a common cause of morbidity and the leading cause of nonfatal injuries and traumarelated hospitalizations.  Falls occur in all types of healthcare institutions and to all patient populations.  In hospitals, falls consistently make up the largest single category of reported incidents. ٢٥
  • 26. IPSG 6: Reduce the Risk of Patient Harm resulting from Falls  Develop P&P using collaborative process  Assess and periodically Reassess each patient’s risk for falling, including the potential risk associated with the patient’s medication regime,  Take action to decrease or eliminate any identified risks. A fall can be prevented by thoughtful strategies designed for the individual patient (e.g., a low bed). ٢٦
  • 27. Improving Patient Safety means . . . Reducing Medical Errors Reducing HAIs ٢٧
  • 28. WHO Patient Safety    WHO Patient Safety was launched in October 2004 with the mandate to reduce the adverse health and social consequences of unsafe health care An essential element of WHO Patient Safety is the formulation of a Global Patient Safety Challenge: a topic that covers a significant aspect of risk to patients receiving health care, relevant to every WHO Member State The First Global Patient Safety Challenge was launched in 2005 ٢٨
  • 29. Through the promotion of best practices in hand hygiene, the First Global Patient Safety Challenge aims to reduce health care-associated infection (HCAI) worldwide ٢٩
  • 30. HCAI rates reported from developing countries Type of survey Prevalence Incidence (%) (%) Incidence (per 1000 patient-days) Hospital-wide 4.6–19.1 2.5–5.1 9.7–41.0 Adult ICU 18.4–77.2 4.1–38.9 18.2–90.0 Neonatal ICU 2.9–57.7 2.6–62.0 SSI Incidence (per 1000 device-days) 1.2–38.7 VAP 2.9–23.0 CR*-BSI 1.7–44.6 CR*-UTI 3.2–51.0 WHO Guidelines on Hand Hygiene in Health Care (2009) ٣٠
  • 31. Device-associated infection rates in ICUs in developing countries compared with NHSN rates Surveillance network, study period, country Setting N° patients CLA-BSI* VAP* CR-UTI* INICC, 2002–2007, 18 developing countries†1 PICU 1,808 6.9 7.8 4.0 NHSN, 2006–2007, USA2 PICU / 2.9 2.1 5.0 INICC, 2002–2007, 18 developing countries†1 Adult ICU # 26,155 8.9 20.0 6.6 NHSN, 2006–2007, USA2 Adult ICU# / 1.5 2.3 3.1 * Overall (pooled mean) infection rates/1000 device-days INICC = International Nosocomial Infection Control Consortium; NHSN = National Healthcare Safety Network; PICU = paediatric intensive care unit; CLA-BSI = central line-associated bloodstream infection; VAP = ventilator-associated pneumonia; CR-UTI = catheter-related urinary tract infection. Rosenthal V et al. Am J Infect Control 20081 rgentina, Brazil, Chile, Colombia, Costa Rica, Cuba, El Salvador, NHSN report. Am J Infect Control 2008† 2 Nigeria, Peru, Philippines, Turkey, Uruguay India, Kosova, Lebanon, Macedonia, Mexico, Morocco, Medical/surgical ICUs # ٣١
  • 32. Most frequent sites of infection and their risk factors URINARY TRACT INFECTIONS Urinary catheter Urinary invasive procedures 34% 13% Advanced age Severe underlying disease Urolitiasis Pregnancy Diabetes Most common sites LACK OF of health careassociated infection HAND and the risk factors SURGICAL SITE INFECTIONS underlying the HYGIENE Inadequate antibiotic prophylaxis occurrence of Incorrect surgical skin preparation infections Inappropriate wound care Surgical intervention duration Type of wound Poor surgical asepsis Diabetes Nutritional state Immunodeficiency Lack of training and supervision LOWER RESPIRATORY TRACT INFECTIONS Mechanical ventilation Aspiration Nasogastric tube Central nervous system depressants Antibiotics and anti-acids Prolonged health-care facilities stay Malnutrition Advanced age Surgery Immunodeficiency BLOOD INFECTIONS Vascular catheter Neonatal age Critical care Severe underlying disease Neutropenia Immunodeficiency New invasive technologies Lack of training and supervision 17% 14% ٣٢
  • 33. HOSPITAL ENVIRONMENT HIV TB ٣٣
  • 34. How are infections transmitted? ٣٤
  • 35. How to Break the Chain of Infection???? ٣٥
  • 36. Hand hygiene is the simplest, most effective measure for preventing Healthcare -Associated Infections. ٣٦
  • 37. ٣٧
  • 38. ٣٨
  • 39. 30%-40% of all HAIs are Attributed to Cross Transmission: ٣٩
  • 40. ٤٠
  • 41. What is the KKH Multimodal Hand Hygiene Improvement Strategy? ONE System change  Based on the evidence and recommendati ons from the WHO Guidelines on Hand Hygiene in Health Care (2010), a number of components make up an effective multimodal strategy for hand hygiene Access to a safe, continuous water supply as well as to soap and towels; readily accessible alcohol-based handrub at the point of care TWO Training / Education Providing regular training to all health-care workers THREE Evaluation and feedback Monitoring hand hygiene practices, infrastructure, perceptions and knowledge, while providing results feedback to healthcare workers FOUR Reminders in the workplace Prompting and reminding health-care workers FIVE Institutional safety climate Creating an environment and the perceptions that facilitate awareness-raising about patient safety issues ٤١
  • 42. So Why All the Fuss About Hand Hygiene? Most common mode of transmission of pathogens is via hands!  Infections acquired in healthcare  Spread of antimicrobial resistance ٤٢
  • 43. All health care’s works involve the hands ٤٣
  • 44. Hands are contaminated Hands spread germs ٤٤
  • 45. The health care environment is contaminated ٤٥
  • 46. The inanimate environment is a reservoir of pathogens X represents a positive Enterococcus culture The pathogens are ubiquitous ~ Contaminated surfaces increase cross-transmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2007, Chicago, IL. ٤٦
  • 47. The inanimate environment is a reservoir of pathogens Recovery of MRSA , VRE & ACINITOBACTER. Devine et al. Journal of Hospital Infection. 2007;43;72-75 Lemmen et al Journal of Hospital Infection. 2004; 56:191-197 Trick et al. Arch Phy Med Rehabil Vol 83, July 2006 Walther et al. Biol Review, 2007:849-869 ٤٧
  • 48. The Iceberg Effect Infected Colonized ٤٨
  • 49. Colonized or Infected: What is the Difference?  People who carry bacteria without evidence of infection (fever, increased white blood cell count) are colonized  If an infection develops, it is usually from bacteria that colonize patients  Bacteria that colonize patients can be transmitted from one patient to another by the hands of healthcare workers ٤٩
  • 50. Patients are vulnerable to infection ٥٠
  • 51. ٥١
  • 52. Types of Hand Hygiene  Normal hand washing  Antiseptic hand washing  Alcohol-based hand rub Can be used instead of hand washing , if hands are not visibly soiled with blood or any other patient body fluids  Surgical hand wash ٥٢
  • 53. Routine Hand Washing ٥٣
  • 54. Antiseptic Hand Washing ٥٤
  • 55. Waterless Hand Rub “alcohol-based hand rub ٥٥
  • 56. Efficacy of Hand Hygiene Preparations in Killing Bacteria Good Plain soap Better Antimicrobial soap Best Alcohol-based hand rub Guideline for Hand Hygiene in Health-Care Settings MMWR,2010. vol. 51, no. RR-16. ٥٦
  • 57. Hand Hygiene Options Wet hands, apply soap and rub for >10 seconds. Rinse, dry & turn off faucet with paper towel. Apply to palm; rub hands until dry ~ Use soap and water for visibly soiled hands ~ ~ Do not wash off alcohol handrub ~ ٥٧
  • 58. Surgical Hand Wash ٥٨
  • 59. ٥٩
  • 60. ٦٠
  • 61. Areas Most Frequently Missed HAHS © 1999 ٦١
  • 62. Hand Hygiene Compliance Hand Hygiene Comment Typical Compliance Observational studies of hand hygiene report compliance rates of 5-81% Common Reported Barriers To Compliance Insufficient time, understaffing, patient overcrowding, lack of knowledge of hand hygiene guidelines, skepticism about hand washing efficacy, inconvenient location of sinks and hand disinfectants and lack of hand hygiene promotion by the institution ٦٢
  • 63. With hand hygiene they’re dead ٦٣
  • 64.  Skin irritation  Inaccessible hand washing facilities  Wearing gloves  Too busy  Lack of appropriate staff  Being a physician (“Improving Compliance with Hand Hygiene in Hospitals” Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381) ٦٤
  • 65. Why Not?  Working in high-risk areas  Lack of hand hygiene promotion  Lack of role model  Lack of institutional priority  Lack of sanction of noncompliers ٦٥
  • 66. Successful Promotion      Education Routine observation & feedback Engineering controls  Location of hand basins  Possible, easy & convenient  Alcohol-based hand rubs available Patient education (Improving Compliance with Hand Hygiene in Hospitals. Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381) ٦٦
  • 67. Successful Promotion   Reminders in the workplace  Promote and facilitate skin care  Avoid understaffing and excessive workload; Nursing shortages have caused ٦٧
  • 68. Clean Care is Safer Care The First Global Patient Safety Challenge SAVE LIVES: Clean Your Hands 5 May 2009–2020 Through an annual day focused on hand hygiene improvement in health care, this initiative promotes continual, sustainable best practice in hand hygiene at the point of care in all health-care settings around the world ٦٨
  • 69. ٦٩
  • 70. Hand Care  Nails  Rings  Hand creams  Cuts & abrasions  “Chapping”  Skin Problems ٧٠
  • 71. Fingernails & Artificial Nails  Keep fingernails short   Allows thorough cleaning and prevents glove tears Long nails make glove placement more difficult and may result in glove perforation ٧١
  • 72. Fingernails & Artificial Nails  Follow MCH policy regarding artificial fingernails; use of artificial fingernails is not allowed. USAF Guidelines for Infection Control in Dentistry, 2004. ٧٢
  • 73. What is the Story on Moisturizers and Lotions? ONLY USE facility-approved and supplied lotions Because:  Some lotions may make medicated soaps less effective  Some lotions cause breakdown of latex gloves  Lotions can become contaminated with bacteria if dispensers are refilled ~ Do not refill lotion bottles ~ ٧٣
  • 74. Gloves are not substitute for Gloves are not a a substitute for handwashing! handwashing! ≠ ٧٤
  • 75. Wearing gloves does not replace the need for hand hygiene  Small, inapparent defects  Frequently torn during use  Hands frequently become contaminated during removal DeGroot-Kosolcharoen 2004, Korniewicz 1999, Kotilainen 2001, Olsen 1998, Larson 2005, Murray 2001, Burke 2005, Burke 1990, Nikawa 1994, Nikawa 2006, Otis 2007 ٧٥
  • 76. What is the single most important reason for healthcare workers to practice good hand hygiene? 1. To remove visible soiling from hands 2. To prevent transfer of bacteria from the home to the hospital 3. To prevent transfer of bacteria from the hospital to the home 4. To prevent infections that patients acquire in the hospital ٧٦
  • 77. How often do you clean your hands after touching a PATIENT’S INTACT SKIN (for example, when measuring a pulse or blood pressure)? pressure)? 1. Always 2. Often 3. Sometimes 4. Never ٧٧
  • 78. Estimate how often YOU clean your hands after touching a patient or a contaminated surface in the hospital? 1. 25% 2. 50% 3. 75% 4. 90% 5. 100% ٧٨
  • 79. Which hand hygiene method is best at killing bacteria? 1. Plain soap and water 2. Antimicrobial soap and water 3. Alcohol-based hand rub ٧٩
  • 80. Which of the following hand hygiene agents is LEAST drying to your skin? 1. Plain soap and water 2. Antimicrobial soap and water 3. Alcohol-based hand rub ٨٠
  • 81. It is acceptable for healthcare workers to supply their own lotions to relieve dryness of hands in the hospital. 1. Strongly agree 2. Agree 3. Don’t know 4. Disagree 5. Strongly disagree ٨١
  • 82. Healthcare-associated organisms are commonly resistant to alcohol. 1. Strongly agree 2. Agree 3. Don’t know 4. Disagree 5. Strongly disagree ٨٢
  • 83. When a healthcare worker touches a patient who is COLONIZED, but not infected with resistant organisms (e.g., MRSA or VRE) the HCW’s hands are a source for spreading resistant organisms to other patients. 1. Strongly agree 2. Agree 3. Don’t know 4. Disagree 5. Strongly disagree ٨٣
  • 84. A co-worker who examines a patient with VRE, then borrows my pen without cleaning his/her hands is likely to contaminate my pen with VRE. 1. Strongly agree 2. Agree 3. Don’t know 4. Disagree 5. Strongly disagree ٨٤
  • 85. How often do you clean your hands after touching an ENVIRONMENTAL SURFACE near a patient (for example, a countertop or bedrail)? 1. Always 2. Often 3. Sometimes 4. Never ٨٥
  • 86. Use of artificial nails by healthcare workers poses no risk to patients. 1. Strongly agree 2. Agree 3. Don’t know 4. Disagree 5. Strongly disagree ٨٦
  • 87. ٨٧
  • 88. Glove use for all patient care contacts is a useful strategy for reducing risk of transmission of organisms. 3. Don’t know 4. Disagree 5. Strongly disagree ٨٨
  • 89. ٨٩
  • 90. ٩٠
  • 91. Infection Control is Everyone’s Responsibility! ٩١
  • 92. Each Healthcare Provider is like a piece of a jigsaw puzzle: each piece needs to fit together to form a best Infection Control Practices! Respiratory Therapists Physicians Paramedics Nurses Patient/ Family Administrative Staff Pharmacists Patient Care Assistant Non Clinical Staff Dieticians Phlebotomists ٩٢
  • 93. Teamwork and Effective Communication For Patient Safety ٩٣
  • 94. ٩٤
  • 95. HAND HYGIENE AWARENACE ٩٥